[即时检测B型利钠肽及GRACE评分在急性冠脉综合征患者中的预后价值]

[Prognostic value of point of care B-type natriuretic peptide testing and GRACE score in patients with acute coronary syndrome].

作者信息

Sun Yi-hong, Wang Gui-lian, Fu Yuan-yuan, Xue Chao, Hu Da-yi

机构信息

Department of Cardiology, Peking University People's Hospital, Beijing 100044, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Aug;37(8):716-20.

PMID:20021924

Abstract

OBJECTIVE

To compare the prognostic value of B-type natriuretic peptide (BNP) and GRACE score in patients with acute coronary syndrome.

METHODS

A total of 246 patients with chest pain to hospital time < 24 hours were followed up to 30 days. Admission plasma B-type natriuretic peptide was measured by point-of-care. Endpoints included death, reinfarction, recurrent ischemia and new onset of congestive heart failure. The receiver operating characteristic (ROC) curve was used to evaluate prognostic value of BNP and GRACE score. The logistic regression models were used to assess the prognostic contribution of BNP level and GRACE score.

RESULTS

The mean age was (67.6 +/- 12.0) years (61.8% males) and ST elevation myocardial infarction (STEMI) was diagnosed in 135 patients (54.9%). During the follow up, 34 endpoints (13.8%) were recorded including 9 deaths (3.7%). The systolic blood pressure [(121 +/- 29) mm Hg vs. (130 +/- 23) mm Hg, P = 0.034; 1 mm Hg = 0.133 kPa] was significantly lower while the heart rate and plasma creatinine were significantly higher in the endpoints group than in non-endpoints group. TNI and CRP levels were similar between the two groups. The BNP level at admission (median 883.5 ng/L vs. 216.5 ng/L) and GRACE score (median 164.5 vs. 142.0) were significantly higher in the endpoints group than in non-endpoints group (all P < 0.05). The prognostic criteria for BNP level (area under cure, 0.704) was 194.5 ng/L determined by ROC (P = 0.043). For GRACE score, the predictive value for endpoints was 0.742 (P = 0.003) and the cut-off point was 158. In the logistic regression model, BNP concentration (> 194.5 ng/L, OR = 3.174) and GRACE score (> 158, OR = 4.031) were independent predictors of endpoints in patients with ACS.

CONCLUSION

Both BNP level at admission and GRACE score were independent predictors for endpoints at 30 days in patients with ACS.

摘要

目的

比较B型利钠肽（BNP）和GRACE评分对急性冠脉综合征患者的预后价值。

方法

对246例胸痛发作至入院时间<24小时的患者进行30天随访。采用即时检测法测定入院时血浆B型利钠肽水平。观察终点包括死亡、再梗死、复发性缺血和新发充血性心力衰竭。采用受试者工作特征（ROC）曲线评估BNP和GRACE评分的预后价值。使用逻辑回归模型评估BNP水平和GRACE评分的预后贡献。

结果

患者平均年龄为（67.6±12.0）岁，男性占61.8%，135例（54.9%）诊断为ST段抬高型心肌梗死（STEMI）。随访期间，记录到34个观察终点（13.8%），包括9例死亡（3.7%）。观察终点组的收缩压[（121±29）mmHg对（130±23）mmHg，P = 0.034；1 mmHg = 0.133 kPa]显著低于非观察终点组，而心率和血浆肌酐水平显著高于非观察终点组。两组的肌钙蛋白和CRP水平相似。观察终点组入院时的BNP水平（中位数883.5 ng/L对216.5 ng/L）和GRACE评分（中位数164.5对142.0）显著高于非观察终点组（均P<0.05）。ROC确定的BNP水平预后标准（曲线下面积，0.704）为194.5 ng/L（P = 0.043）。对于GRACE评分，观察终点的预测值为-0.742（P = 0.003），截断点为158。在逻辑回归模型中，BNP浓度（>194.5 ng/L，OR = 3.174）和GRACE评分（>158，OR = 4.031）是急性冠脉综合征患者观察终点的独立预测因素。